The targets culture skews clinical priorities and wastes resources

Posted 17 August 2016 - 13:55

RCN Scotland director Theresa Fyffe calls for a radical new approach to how we measure success in our healthcare services

Healthcare targets have been in the news a lot and not in ways which offer comfortable reading for governments across the UK. Missed emergency department waiting time targets and patients having to wait longer for treatments have made headlines.

Current targets measure how long it takes our health services to deliver. Photo: iStock

It is the word time that presents a challenge to many healthcare professionals. What current targets measure is how long it takes our health services to deliver.

Its true that speed is sometimes of the essence when it comes to health, and no patient, nurse or doctor wants to go back to a time when waiting 2 years for a hip replacement was the norm and patients sat for hours

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RCN Scotland director Theresa Fyffe calls for a radical new approach to how we measure success in our healthcare services

Healthcare targets have been in the news a lot – and not in ways which offer comfortable reading for governments across the UK. Missed emergency department waiting time targets and patients having to wait longer for treatments have made headlines.

Current targets measure how long it takes our health services to deliver. Photo: iStock

It is the word ‘time’ that presents a challenge to many healthcare professionals. What current targets measure is how long it takes our health services to deliver.

It’s true that speed is sometimes of the essence when it comes to health, and no patient, nurse or doctor wants to go back to a time when waiting 2 years for a hip replacement was the norm and patients sat for hours in the emergency department waiting to be seen. But current high-profile targets don’t tell us how successful treatment has been or whether an individual’s health has improved as a result of the care they have received. Too often they miss the point of health care.

Pervasive and wrong

RCN Scotland and the Academy of Medical Royal Colleges and Faculties in Scotland published a joint statement on NHS sustainability in June 2015. We said the approach to targets, while having initially delivered some real improvements, is now creating an unsustainable culture that pervades the NHS and often skews clinical priorities, wastes resources and focuses energy on too many of the wrong things.

Since then the RCN has engaged with members, partner organisations across the third, independent and social care sectors and political parties to ask how Scotland should measure success in health and well-being. This engagement has underlined our belief in the importance of collaborative development and ownership of success in health and wellbeing.

From these discussions came Measuring Success: Principles for a new approach to improving health and wellbeing in Scotland, which we published in June this year.

It delivers on the promise made in our joint statement with the academy, to develop principles for a new approach to measuring success, which focuses on outcomes for people who need to use services and on sustainable improvement across health and wellbeing services.

What patients want

Our 9 principles focus on Scotland having a single set of health outcomes across all services. We also believe that clear, public accountability is crucial, so that health and wellbeing services deliver what matters to people. Individuals must be listened to by their health and care professionals and supported to achieve their personal health outcomes. But this will only be achieved if a new approach also builds on the vast experience and expertise of nurses, other health professionals and the people using services.

Trusting professional judgement and allowing clinicians to use their skills and experience in making decisions in partnership with patients and others would be a powerful way of transforming a target-focused culture.

We were told clearly in our discussions that we need to rebalance the culture of health services away from a top-down, target-driven performance management system to one of continuous improvement rather than blame.

Influence of nurses

The day before the RCN launched its report, the Scottish government announced a review of NHS targets. This is an important marker of the influence of nurses in shaping healthcare targets. However that review now takes shape, we are clear it must focus on a fundamental reshaping of what success looks like.

The new approach must be developed in partnership, must be fully planned and has to be phased responsibly so that Scotland can have truly sustainable health and wellbeing services that work for the patient and the health professional.

Only by radically changing our approach to how we measure health and wellbeing success will tomorrow’s headlines better reflect the hard work and dedication of nursing and other staff in our health services.